Provider Demographics
NPI:1194818088
Name:THYER, ANGELA C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:THYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WESTLAKE AVE N
Mailing Address - Street 2:#400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3050
Mailing Address - Country:US
Mailing Address - Phone:206-301-5000
Mailing Address - Fax:
Practice Address - Street 1:1505 WESTLAKE AVE N
Practice Address - Street 2:#400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3050
Practice Address - Country:US
Practice Address - Phone:206-301-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG68987Medicare UPIN